Anatomical variant of the superficial temporal artery in temporoparietal fascia flap for microtia reconstruction

Abstract

BackgroundSingle-stage microtia auricular reconstruction is becoming more relevant. The determining factor is a temporoparietal fascia flap (TPF) with both branches of the superficial temporal artery (STA). There are not many studies regarding vascular branching in microtia peoples. MethodsWe conducted an anatomical study on TPF flap harvested during single-stage endoscopic assisted microtia auricular reconstruction from May 2018 to July 2021. We observed the flaps under endoscopic and surgical microscopes to determine several variables (vascular size, number of frontal/parietal branches, distance from branching location to estimated external ear canal, distance from frontal artery to projected course of facial nerve’s frontal branch, etc). ResultsThe study included 55 flaps from 54 patients. 50/55 (90,9%) had a parietal branch, and 55/55 (100%) had a frontal branch with a mean diameter of 0.98 and 0.91mm, respectively. Regarding the frontal artery, 1.8%, 25.5%, 50.9%, 16.35, and 5.45% had 0-4 traverse frontal branch(es), respectively. The mean distance from the frontal artery to the estimated course of the frontal nerve was 10.56mm. Parietal artery absence is more likely in patients with severe hemifacial microsomia or STA trunk go under the auricular cartilage remnants (p <0.05). Either frontal or parietal artery absence or small diameter can cause necrosis. Frontal arteries travelling near the frontal nerve may result in post-op nerve palsy. ConclusionsMicrotia auricular reconstructive surgery is always a big challenge for plastic surgeons. Anatomical variants are common. Detailed anatomical description of the STA with the help of microsurgery and endoscopy help allow arterial-based flap designing and harvest, which tremendously improve surgical success rate by diminishing flap necrosis and nerve damages. CLINICAL QUESTION/LEVEL OF EVIDENCETherapeutic, IV.